Scurvy is a disease resulting from a deficiency of vitamin C. Scurvy often presents initially with fatigue, followed by formation of spots on the skin, spongy gums, and bleeding from the mucous membranes. Spots are most abundant on the thighs and legs, and a person may look pale, feel depressed, and be partially immobilized. As scurvy advances, there can be open, suppurating wounds, loss of teeth, yellow skin, fever, neuropathy and finally death from bleeding.
I grew curious about scurvy while listening to a Civil War lecture. During one particular battle it was estimated that up to one third of the confederate army was suffering from scurvy at one level or another. Most were simply prone to lethargy and this ultimately played out in the outcome of the battle as the physical stamina of the confederate forces did not match that of their union counterparts despite starting out the battle with advantages in positions. At this time the confederate army was coming out of winter and had been relying on a diet almost exclusively comprised of salt pork and corn meal.
During the Civil War, scurvy rates continually increased, from less than .5% prior to the war to nearly 3% just after the end of combat. However, these figures show a vast amount of underreporting because only soldiers who died from scurvy or were sent to hospitals would have been counted in the total. For example, if one soldier in a group was sent to an army hospital for scurvy, only he would count towards the scurvy total. However, it would be likely that the entire group was suffering from malnutrition and likely was suffering from at least a milder case of scurvy.
During the age of sail Scurvy killed more sailors than all battles, storms and other diseases combined from the 16th to 18th centuries.
So what is the modern application? Day to day it is extremely minimal outside of basic effects of vitamin deficiency due to poor diet. Scurvy, while uncommon, still occurs in developed countries despite the widespread availability of vitamins and fortified foods. A vitamin C deficiency prevalence of 10 to 14% in adults was reported in the National Health and Nutrition Examination Survey (NHANES) in 1994.
During times of duress in our modern world nutrition related sickness continues to be prevalent. While we may not undergo another civil war or risk foreign invasion, a national depression always seems to be looming around the corner. An excerpt on one particular refugee camp of the Great Depression stated: “…More than 350 people lived there at any one time. Substandard living conditions and inadequate nutrition in these camps left residents prone to scurvy, lice and the infectious diseases dysentery whopping cough…”
How does this old and almost un-experienced (in our day) disease play into preparedness. Day to day, not really; our diets are typically too enhanced and vitamin fortified. But in the advent of economic down turn, or something more catastrophic that stops the flow of trucking to your local grocery store are you prepared? Do you have a garden with plenty of fruits and vegetables? Is your food storage more than just rice and beans? Do you have a stock of vitamins? Do you know what local vegetation can give you vitamin C and other necessary nutrients? Vitamin deficiency is easily treatable, especially vitamin C deficiency.
Signs and symptoms
The body gives several warning signs when vitamin C deficiency has reached dangerous levels. Paying attention to these sings could save your life.
Bleeding gums, gingivitis or loose teeth. Vitamin C is necessary for collagen which builds and maintains tissue.
Lack of energy or depression. People with vitamin C deficiency may lose weight and suffer extreme fatigue. Depression is common.
Mood swings. Irritability and rapid changes in mood may indicate a severe deficiency.
Chronic joint pain. Serious deficiencies will lead to bleeding in the joints causing constant pain.
Suppressed immune system. People who seem to be sick all the time are often lacking in immune-boosting vitamin C.
Slow wound healing and bruising. Without adequate vitamin C bruising occurs easily and wounds take a long time to heal.
After 1–3 months, patients develop shortness of breath and bone pain.
Myalgias may occur because of reduced carnitine production.
Dry mouth and dry eyes similar to Sjögren’s syndrome may occur.
In the late stages, jaundice, generalized edema, oliguria, neuropathy, fever, convulsions, and eventual death are frequently seen.
Symptoms which may appear before any physical changes include skin changes with roughness, easy bruising and petechiae, gum disease, loosening of teeth, poor wound healing, and emotional changes.
Scurvy or subclinical scurvy is caused by the lack of vitamin C. In modern Western societies, scurvy is rarely present in adults, although infants and elderly people are affected. Vitamin C is destroyed by the process of pasteurization, so babies fed with ordinary bottled milk sometimes suffer from scurvy if they are not provided with adequate vitamin supplements. Virtually all commercially available baby formulas contain added vitamin C for this reason, but heat and storage destroy vitamin C. Human breast milk contains sufficient vitamin C, if the mother has an adequate intake.
Scurvy is one of the accompanying diseases of malnutrition (other such micronutrient deficiencies are beriberi or pellagra) and thus is still widespread in areas of the world depending on external food aid. Though rare, there are also documented cases of scurvy due to poor dietary choices by people living in industrialized nations.
Ascorbic acid is needed for a variety of biosynthetic pathways, by accelerating hydroxylation and amidation reactions. In the synthesis of collagen, ascorbic acid is required as a cofactor for prolyl hydroxylase and lysyl hydroxylase. These two enzymes are responsible for the hydroxylation of the proline and lysine amino acids in collagen. Hydroxyproline and hydroxylysine are important for stabilizing collagen by cross-linking the propeptides in collagen. Defective collagen fibrillogenesis impairs wound healing. Collagen is an important part of bone, so bone formation is affected. Defective connective tissue leads to fragile capillaries, resulting in abnormal bleeding.
Scurvy can be prevented by a diet that includes certain citrus fruits such as oranges or lemons. Other sources rich in vitamin C are fruits such as blackcurrants, guava, kiwifruit, papaya, tomatoes, bell peppers, and strawberries. It can also be found in some vegetables, such as carrots, broccoli, potatoes, cabbage, spinach and paprika. Some fruits and vegetables not high in vitamin C may be pickled in lemon juice, which is high in vitamin C. Though redundant in the presence of a balanced diet, various nutritional supplements are available that provide ascorbic acid well in excess of that required to prevent scurvy, and even some candies contain vitamin C as a preservative.
Many animal products, including liver, Muktuk (whale skin), oysters, and parts of the central nervous system, including the brain, spinal cord, and adrenal medulla, contain large amounts of vitamin C, and can even be used to treat scurvy.
Fresh meat from animals which make their own vitamin C (which most animals do) contains enough vitamin C to prevent scurvy, and even partly treat it. This caused confusion in the early history of scurvy, since the disease was only seen in people eating long-preserved diets or canned goods, but not in people eating any sort of fresh diet, including arctic diets primarily based upon meat. In some cases (notably in French soldiers eating fresh horse meat), it was discovered that meat alone, even partly cooked meat, could alleviate scurvy. In other cases, a meat-only diet could cause scurvy. Some of these observations that scurvy was associated only with preserved foods prompted explorers to blame scurvy upon some type of tainting or poison which pervaded tinned foods.
Scurvy can be treated by eating vitamin C-rich foods (such as oranges, papaya, strawberries, lemons) and by ingesting vitamin C tablets.
Untreated scurvy is invariably fatal. However, death from scurvy is rare in modern times. Since all that is required for a full recovery is the resumption of normal vitamin C intake, it is easy to treat if identified correctly. Consumption of dietary supplements and/or citrus fruits are means by which to accomplish